Stricter training rules for health care navigators raise questions

Proposed guidelines for navigators called politically motivated

AUSTIN - Proposed rules for navigators who help Texans sign up for insurance under the federal Affordable Care Act far exceed what is required of similar workers hired by the state to help residents enroll in Medicare, Medicaid, food stamps and other benefit programs.

"It's a remarkable difference," said Stacey Pogue, a senior policy analyst at the nonpartisan Center for Public Policy Priorities, an advocate for low- and moderate-income Texans.

Gov. Rick Perry, an outspoken critic of the ACA, last September called on the state insurance regulator to develop strict new rules for the health care navigators, prompting Obama administration officials to accuse him of a "blatant attempt to add cumbersome requirements" in an effort to keep uninsured Texans from learning about or signing up for insurance coverage.

Perry has said the rules, which are stricter than federal requirements, were needed to protect Texans and their confidential information, including birth dates, Social Security numbers and financial information.

The proposed rules being developed by Texas Department of Insurance Commissioner Julia Rathgeber would require health care navigators receive an additional 40 hours of training on top of the 20 to 30 hours required by federal law. The rules would require navigators hired by local organizations through a federal grant to take an additional 40 hours of training on Medicaid rules, ethics and privacy.

ACA navigators also would pay training fees of up to $800, an additional $120 for six hours of continued education, plus a $50 registration fee. They also would have to undergo a criminal background check and a fingerprinting process that could cost up to $62, prove their U.S. citizenship, and provide documentation of their educational credentials.

By comparison, Texas Department of Insurance-certified counselors under the Health Insurance Advocacy and Counseling Program -which provides enrollment assistance on Medicare benefits - are required to complete 25 hours of training.

Fewer requirements

Navigators who help citizens enroll in Medicaid, the Children's Health Insurance Program, the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families are required to take only four hours of training. Those navigators operate under the Texas Health and Human Services Commission's Community Partner program.

Counselors working in those programs do not have to pay fees for training or continuing education. They also do not have to submit to fingerprinting or criminal background checks.

Pogue said ACA navigators perform most of the same tasks as their counterparts working in the Community Partner and Health Insurance Advocacy and Counseling programs. She said the Department of Insurance has yet to justify why health care navigators would have higher training requirements than their counterparts in the other two programs.

"There's no reason for the discrepancy," Pogue said.

The proposed rules came after Perry and Attorney General Greg Abbott expressed concerns about navigators' access to private information.

"Because of the nature of navigators' work and because they will be collecting confidential information, including birth dates, Social Security numbers and financial information, it is imperative that Texas train navigators on the collection and security of such data," Perry said in a September letter to Rathgeber.

States control rules

Navigators do not keep applicants' private information on file, Pogue said. That information is plugged into the federal healthcare.gov website, she said, which navigators cannot access without applicants present.

State Rep. Lon Burnam, D-Fort Worth, a member of the House Criminal Jurisprudence Committee, said he has seen internal agency documents that show the requirements were created arbitrarily and resulted from political influence. He said he was told by the agency not to release them to the public.

John Greeley, a Texas Department of Insurance spokesman, said some of the documents the agency provided to Burnam contained personally identifiable information for agency employees such as Social Security numbers, preventing their release to the public.

Greeley said the agency could not comment on allegations that the proposed rules were formed with political motivations.

Under the federal health care law, states are allowed to create their own guidelines and standards for navigators.

Texas guidelines were included in a bill by state Sen. Kirk Watson, D-Austin, passed last year.

The bill prohibited navigators from engaging in conflicts of interest and favoring specific insurance plans. It allowed the agency to write additional rules in a "good faith" effort where it saw fit.

Watson said he did not anticipate the "good faith" clause in the bill to be used as "a political tool in a political battle over the Affordable Care Act."

"If what we were to do simply say that we're not going to file legislation that tries to make things better because you can't trust Rick Perry and his appointees to operate in good faith, I worry we would never file legislation and the people of this state would suffer greatly," Watson said.

Bad timing

The rules proposed by Rathgeber would take effect March 1, one month before the open enrollment period ends.

That timing could spell trouble for navigator organizations in Texas counties if their navigators are out completing additional training.

Paying for those training sessions - which have not been formed - means finding other sources of revenue or dipping into funds that would be better used by serving applicants, said Benjamin Hernandez, deputy assistant director for the Houston Department of Health and Human Services, which has a coalition of 30 individual navigators operating in Harris and surrounding counties.

"We need these people out there serving in the community, not sitting in a classroom," Hernandez said.